BSIPHERD

Yes, you need to continue to give E negative blood. We continue to do AHG crossmatching for any patient with a history of an alloantibody. We would do a regular antibody screen. Of course, if this patient went to a hospital that didn't have the history, he/she might get E Pos blood and then maybe you'd have an amnestic response.

We do a 1:8 dilution and a Modified Antibody Screen (to rule out other antibodies). If the 1:8 is negative and the patient has a history of receiving RhIG recently, we report Probable Passive Anti-D is present in the plasma. It is thought to be passive because the titer is less than 8 and the patient received Rh Immune Globulin on MM/DD/YY.

Thanks for your website. We have used the codabar and are looking forward to more of the ISBT. It has been particularly helpful to us for new employee training and for validating changes. Belva in Lincoln, NE.

Does the patient have positive DAT?

I think it is more correct this way: Original Unit (500 mL) 00 It is split into two parts - 450 mL in original bag becomes AO, 50 mL aliquot and is B0. Original bag stays A0. A second 50 mL aliquot is taken from the original bag. It is Aa. Original bag (A0) is now 400 mL. A third 50 mL aliquot is taken from the original bag. It is Ab. Original bag (A0) is now 350 mL. A fourth 50 mL aliquot is taken from the original bag. It is Ac. Original bag (A0) is now 300 mL. Etc Belva in Lincoln, NE

I think you mean ITP, not TTP.

Welcome back! It's always great to hear input from someone as highly regarded as you are. Belva Sipherd

Was the DAT positive? Did you do an eluate? Had the patient received any IV IgG med? Had the patient received any blood products recently?

Yes, this is what we do also. The AABB Technical Manual 15th ed (p. 794) states about the rosette test "If the infant's cells are shown to be weak D, a negative result on the mother's specimen should be interpreted with caution. In this situation, a quantitative test that does not rely on D antigen expression should be performed."

Maybe you have Sunquest? We have the same problem. What we have done is use the E codes to name all our products (Ennnn). This works for everything except Autologous, Directed, and Splits. For Auto/Dir, we use EAnnn for Auto (100 or A00 - our supplier uses 100), EXnnn for Biohazard Auto (X00), and ED for directed (200 or D00 - our supplier uses 200). For splits, we use the last two characters of the product code and the four numbers of the E code (with Sunquest we can only use up to six characters for product code). So if we split an E0382V00 in a closed system into two parts, we would have E0382VA0 and E0382VB0. Our codes for the splits would be A00382 and B00382. If one of the divided units was further split - such as a syringe taken off the B0 unit, it would become E0382VBa and our code would be BA0382. We can scan the product codes for Auto and Directed and all is well. However, we can't yet for the split unit, so we have to type those in. A future update for Sunquest (available now I think) does have the ability to scan the last two characters (00, A0, Ba, etc.). So when we get that update, we will add them to the Bar code dictionary, but we won't change our component codes. Hope this is helpful. Belva Sipherd:)

I wasn't taking issue with your decision to use a second specimen, or with your logic. I was only taking issue with the comment: "A second type on the same sample is of no value what so ever. If you are going to required a second type any thing other than a new sample is nothing more than smoke and mirrors!!" I think saying it's of no value what so ever is not valid. There is a price to pay for the second specimen choice - heavier workload for phlebotomy personnel (or as in at least one place where nurses collect specimens, them drawing two specimens at once, keeping one available to add a new time to if a second specimen is called for), transfusing more group O blood to non-group O patients (at least one expert thinks this is not a good thing to do medically and of course, you have less group O blood for group O patients with whatever consequences that may have), and we would charge for it. But regardless whether it's charged for or not, it adds another cost to the medical system in added workload and supplies. If you do one thing with the dollars, you can't do another.

I beg to differ! In the 30 years I have been in my current job, there have been 2 or 3 occasions when the wrong blood was given. Luckily, the patients suffered no long term injury. In no instance was it due to "wrong blood in tube". Due to those problems, we require a second type on the current specimen if we do not have a historical type. The second type has to be done separated in time from the first, and has to be done on a new cell suspension. After the initial type is done, units are selected. Then (after the mind is cleared from the first type) the specimen is re-identified, a new cell suspension is made, and a second type done. I think you have to look at your own experience of what your problems have been and determine based on that what actions will be helpful.

Each cell used for antibody detection must be checked each day of use for reactivity of at least one antigen using antisera of 1+ or greater avidity. I believe this is talking about the cells used for antibody screening (antibody detection) as opposed to those used for Antibody Identification. On CAP surveys, Antibody Detection and Antibody Identification are different things. So I don't believe this address panel cells, only screening cells.

Congratuations, but we will miss you. I have always enjoyed your posts and looked forward to hearing what you had to say on a subject. I certainly understand what you are saying on salaries. I know with the same talents I could make much more in another field. But I do enjoy the Blood Bank Team and that's what keeps me here. Best Wishes, Belva in Lincoln

We do this as part of our original antibody ID reporting. We generate them from "canned comments" or as we now know them in Misys "English Text Codes". The last comment is "To Be Reviewed by Pathologist". This then goes to a pathologist who reviews, dates, and initials the comment. In Misys 6.2, we will be including this comment as part of the Blood Bank Administrative Data file so information is readily available to the tech performing Blood Bank testing. We find it relatively easy to do and good documentation. Belva in Lincoln, NE

Thanks for making my day! I really enjoy your posts and your sense of humor! Belva in Nebraska

It's hard (probably impossible) to come by absolute guarantees and perfection in life. For just about any process, someone can figure out how to get around it. I think you have to be aware of the types of errors in your institution and work toward improving those. The perfect should not be the enemy of the good.

Several years ago I saw a hemolytic reaction we think was due to Anti-C/e that we could not demonstrate in serologic tests. The patient had a catheter and when we gave blood postive for C and/or e the urine would turn red. When we gave C Neg e Neg blood, it did not. It might be a good idea to do some antigen typing on the patient. For example if patient is ccDEE, you might consider anti-C/e or if patient is Jk(a-), you might think about anti-Jk(a). However, if this just happened with one unit, the possibility of a low incidence antibody is a consideration. Did you repeat the crossmatch with the implicated unit with a pre and post patient specimen?

Mabel, When we don't have a historical type, we require a repeat front type if units are allocated. It can be done by the tech who did the first type. But our requirements are that it be done on a new cell suspension prepared after the units are allocated. The reason for after the units are allocated is to separate the repeat in time from the original type, to make a repeat of the same mistake less likely.

We see this occasionally. When we get a weakly pos DAT on an Rh Pos baby with an Rh Neg Mom who has received RhIG recently, we just report it is probably due to RhIG (or if there is also an ABO incompatibility, we report it may be due to one or the other). If both are true, our comment is "The baby has serologic evidence of ABO HDN. This is shown by a positive DAT and ABO incompatibility between the mother's plasma and the baby's cells. The baby's positive DAT could also be secondary to the administration of antepartum Rh Immune Globulin to the mother. This would not be expected to be clinically significant."

We would do an AHG crossmatch. We have lots of generalists working in the Blood Bank and it easier for them if we do an AHG crossmatch on anyone who has a current or previous alloantibody rather than having to decide what's clinically significant and what's not. Also, since it was undetermined, it's hard to know that it's not reacting now - maybe it's just not present on current screening cells, as would happen with antibodies to low incidence antigens.

For tube DATs, I think it's important to read them microscopically if they are being done as part of a Transfusion Reaction workup.

I for one enjoy your "ramblings" so ramble on! Belva

We do eluates on babies when the DAT is positive and the mother has a clinically significant alloantibody (or reason for positive DAT is unknown). We do not do them when it is due to ABO incompatibility or probably passive anti-D.

We use PeG, not gel, but the situation is the same. We would do a panel and an eluate using PeG. If the patient had a positive DAT and all cells were positive in both plasma (and eluate), we do a LISS screen. If the LISS screen is negative, we report a PeG reactive Warm Autoantibody, and we crossmatches by LISS technique. If the LISS screen was positive, we'd go to warm auto or differential adsorption.